The instant invention relates to the enternal feeding of patients by tube and more particularly to a gastrostomy-jejunal feeding tube which is receivable through the wall of the stomach for feeding and medicating a patient and/or for draining fluids from the patient's stomach.
The use of feeding tubes which extend directly into the stomachs of patients is often required when patients cannot swallow or when they have strictures in their esophagi which prevent food from entering in their stomachs. In a situation of this type it is common to perform a surgical procedure known as a gastrostomy on a patient wherein an opening is formed in the skin, fascia and stomach wall and wherein a gastrostomy tube is installed in the opening to allow food and/or medication to be passed directly into the stomach and also to allow fluids to be drained therefrom. However, although a tube of this type is often necessary for draining fluids from the stomach and it can also be used for introducing feeding formula into the stomach, it has been found that it is preferable to introduce feeding formula into the jejunum portion of the intestines rather than into the stomach. Accordingly, it has been found that in many instances it is preferable to install two separate tubes in a patient, one which extends directly into the stomach for draining fluids therefrom and one which extends through the stomach and into the jejunum portion of the intestines for supplying feeding formula to the patient. However, since an installation of this type requires two semi-permanent openings in the stomach wall, fascia and skin of a patient, it has disadvantages from the standpoint of patient discomfort and it also creates additional sites for infection. In order to overcome this problem, a device known as a Rombeau tube has been used for passing feeding formula into the jejunum of a patient and also for draining fluids from the stomach through a single opening in the stomach wall, fascia and skin of the patient. In this connection, a Rombeau tube generally comprises a gastrostomy tube having an enlarged retainer portion on the distal end thereof and a jejunal feeding tube which is permanently attached to the gastrostomy tube so that it extends therethrough. A device of this type is adapted to be installed in a patient so that the gastrostomy tube portion of the device extends through the skin, fascia and stomach wall, so that the retainer portion is positioned in engagement with the inner side of the stomach wall, and so that the jejunal feeding tube portion extends through the stomach and into the jejunum. Accordingly, the gastrostomy tube portion of a Rombeau tube can be utilized for draining fluids from the stomach, whereas the jejunal feeding tube portion can be utilized for passing medication and feeding formula into the jejunum; and the entire Rombeau tube only requires a single opening in the skin, fascia and stomach wall. However, it has been found that Rombeau tubes nevertheless have several disadvantages. Specifically, it has been found that in the event that the jejunal feeding tube portion of a Rombeau tube becomes clogged with feeding formula or is other rendered inoperative, the entire Rombeau tube must be surgically replaced. Further, it has been found that although it would be preferable to install the gastrostomy tube portion of a Rombeau tube in the stomach of a patient by passing the retainer portion of the gastrostomy tube portion through a small slit or stab wound in the stomach wall and then passing the other end of the gastrostomy tube portion through a small slit or stab wound in the fascia and skin, a surgical procedure of this type is impossible since the enlarged retainer portion of the gastrostomy tube portion of a Rombeau tube cannot be easily passed through a small slit, and since the gastrostomy tube portion is permanently attached to other elements which could not be passed outwardly through a small slit in the fascia and skin. Further, it has been found that the overall surgical procedure which is required to install a Rombeau tube in a patient is made overly complicated by the cumbersome structure thereof which includes a gastrostomy tube and a jejunal feeding tube which is permanently attached to the gastrostomy tube.
The instant invention provides a highly effective feeding tube assembly which overcomes the disadvantages of utilizing separate feeding and drainage tubes, as well as the hereinabove set forth disadvantages of Rombeau tubes. Specifically, the instant invention provides a gastrostomy-jejunal feeding tube comprising a gastrostomy tube including a tubular main portion having distal and proximal ends and an enlarged retainer element on the distal end of the main portion, and a jejunal feeding tube, including a feeding tube element having distal and proximal ends and a weighted bolus on the distal end of the feeding tube element. The jejunal feeding tube is slidably and removably received in the gastrostomy tube, and it is dimensioned and configured so that fluids can pass through the gastrostomy tube despite the presence of the jejunal feeding tube therein. The gastrostomy tube and the jejunal feeding tube portions of the device are further dimensioned and configured so that they are receivable in a patient with the gastrostomy tube positioned so that it extends through the stomach wall, fascia and skin of the patient and so that the retainer element is in engagement with the inner surface of the stomach wall and with the jejunal feeding tube positioned so that the distal end thereof is received in the jejunum of the patient. In the preferred embodiment, the gastrostomy tube has a main lumen therethrough, and the jejunal feeding tube is loosely received in the main lumen so that there is sufficient clearance in the main lumen for fluids to pass therethrough around the jejunal feeding tube, and the enlarged retainer element comprises a plurality of circumferentially-spaced resilient leaves of rounded configuration which extend outwardly from the distal end of the main portion. The retainer element preferably comprises three rounded leaves or flanges, and it preferably further comprises three hub portions which extend outwardly from the main portion by a reduced amount between the leaves. The hub portions preferably extend outwardly by less than approximately 0.25 inches and preferably by approximately 0.125 inches, and the entire retainer portion is preferably integrally formed with the main portion of the gastrostomy tube from a nontoxic rubberized material such as silicone rubber. The feeding tube preferably further comprises a Y-shaped tubular element attached to the proximal end of the gastrostomy tube and the jejunal feeding tube so that one leg of the Y-shaped element communicates with the interior of the gastrostomy tube and so that the jejunal feeding tube passes through the stem of the Y-shaped element and into the other leg. For use and operation of the gastrostomy-jejunal feeding tube of the instant invention, it is preferably sugically installed in a patient by first making a working incision in the skin and fascia of the patient and then making a small slit or stab wound in the stomach wall. The distal end of the gastrostomy tube is then passed through the opening in the skin and fascia and the retainer portion is passed through the small stab wound in the stomach wall by rotating the gastrostomy tube to individually work the resilient leaves through the stab wound until the retainer portion is passed into the stomach. The leaves on the distal end are then positioned adjacent the inner surface of the stomach wall, and sutures are applied to close the stab wound in the stomach wall to secure the tube in place. A small stab wound is then made in the skin and fascia, and the proximal end of the gastrostomy tube is fed through this stab wound, and thereafter the working incision in the skin and fascia is closed and sutured. Finally, after the gastrostomy tube has been fully installed in a patient in this manner, the distal end portion of the jejunal feeding tube is passed through the gastrostomy tube and into the stomach of the patient and then into the jejunum. In this connection, the distal end of the jejunal feeding tube may be installed in the jejunum with a stylet or with an endoscopic device or it may simply be allowed to pass into the jejunum via the peristaltic action of the stomach. In any event, after the gastrostomy tube has been installed in the patient and the distal end portion of the jejunal feeding tube has been passed into the stomach, the Y-shaped element which is preferably permanently attached to the proximal end of the jejunal feeding tube is secured to the proximal end of the gastrostomy tube, and the gastrostomy tube is secured on the skin of a patient with an adhesive clamping device or the like.
After the gastrostomy-jejunal feeding tube of the instant invention has been installed in a patient in the above-described manner, the jejunal feeding tube portion thereof can be effectively utilized for passing feeding formula and medication into the jejunum in order to effectively provide nutrition and medication for the patient. The gastrostomy tube, on the other hand, can be effectively utilized for draining fluids from the stomach of the patient. However, in the event that the jejunal feeding tube portion of the assembly becomes clogged with feeding formula or is otherwise rendered inoperative, it can be withdrawn from the patient by pulling it outwardly through the gastrostomy tube so that it can easily be replaced. In this connection, if the jejunal feeding tube is of the type which has an opening which extends through the terminal end thereof, it may be advantageous to first insert a guide wire or the like into the jejunal feeding tube and to thereafter remove the feeding tube leaving the guide wire in the patient. Thereafter, a new feeding tube can easily be installed in the patient by passing it over the guide wire so that the distal end of the new tube passes into the jejunum, whereupon the guide wire can be removed. In any event, during normal operation of the feeding tube assembly of the instant invention, the leaves of the retainer portion of the gastrostomy tube effectively retain the distal end of the gastrostomy tube in a properly installed position in the stomach of the patient, and the hub portions which extend between the leaves operate to further retain the distal end of the gastrostomy tube in the stomach of the patient. The configuration of the retainer portion also enables the gastrostomy tube to be installed in the patient in the manner hereinabove set forth. Further, in the event that it becomes necessary to remove the gastrostomy tube from the patient, the leaves are collapsible so that the gastrostomy tube can be removed simply by pulling on the proximal end thereof, whereby the leaves are collapsed and pulled through the openings in the stomach wall, fascia and skin. Hence, the gastrostomy tube can be removed without an additional surgical procedure.
Accordingly, it is a primary object of the instant invention to provide an improved gastrostomy-jejunal feeding tube.
Another object of the instant invention is to provide a gastrostomy-jejunal feeding tube comprising a gastrostomy tube and a jejunal feeding tube which is removably-received in the gastrostomy tube. A still further object of the instant invention is to provide a device which can be utilized for draining fluids from the stomach and also for passing feeding formula and medication to the jejunum of a patient.
Other objects, features and advantages of the invention shall become apparent as the description thereof proceeds when considered in connection with the accompanying illustrative drawings.